What do you do when a patient threatens harm? - page 5

So far in my short few months on the floor I've already had a bunch of patients threaten to hit me. Every time I get threatened or yelled at by the public all I can think of is that I'm not getting... Read More

  1. by   OrganizedChaos
    Quote from quiltynurse56
    Sounds like you handled this situation well. Sometimes a little empathy goes a long ways. Elderly with thin skin is fragile skin as you know. You did a good job there.

    For those wondering about the patients where she works, I worked LTC and Rehab for a few months and I tell you, those rehab patients were some of the rudest people I have ever had to care for. I am sure they were the same way in the hospital when they came to us.
    Thank you. I swear, patients (& family members) are just getting rider & ruder!
  2. by   OrganizedChaos
    Quote from JBudd
    Yep, except most of what I've learned can't or shouldn't be used against a patient, lol. But with practice you (I) know what we can do or how to do just enough to defend without going too far.

    My first CPI course taught a variety of HopKiDo techniques, but without frequent practice as said above, they are worthless. But my course was only 4 hours, not 16. I objected, but was told that was the class. My most recent class had security telling us not to try use those kinds of techniques, and refused to teach them, for that very reason. Our class emphasized recognizing a potential situation, keeping a clear path to the door, body posture and language to deescalate instead of provoke, etc.
    But why shouldn't they be used against a patient? If a patient truly is attacking me, why shouldn't I be able to fight back? Don't we all want to go home?

    If I have self defense training & I need to protect myself before security gets there because I'm on the 8th floor, I'm gonna use it. If I don't because the hospital told me no, you bet your sweet behind if I get hurt by the patient I will sue that hospital for everything! I'm not getting hazard pay & there is nothing in my contract about hazard duty.
  3. by   JBudd
    Quote from OrganizedChaos
    But why shouldn't they be used against a patient? If a patient truly is attacking me, why shouldn't I be able to fight back? Don't we all want to go home?

    If I have self defense training & I need to protect myself before security gets there because I'm on the 8th floor, I'm gonna use it. If I don't because the hospital told me no, you bet your sweet behind if I get hurt by the patient I will sue that hospital for everything! I'm not getting hazard pay & there is nothing in my contract about hazard duty.
    LOL, I said most of what I learned: stick fighting, sparring, some really nasty ways to take out an attacker. Yes, I know how to kill, because we have to learn what not to do in order not to kill.

    I have used, as Hppy has, hand or arm hold techniques several times. Security guard looked at me and said "I didn't know you knew how to do that!". I prevented a serious attack on a co-worker by putting a person to the floor, (right in front of people from my church who happened to be there as patients, go preacher's wife!!).

    It is knowing which part of your defense training to use, and not to go beyond what is necessary for protection, is what I meant. The CPI taught some techniques but they are just as likely to backfire if you don't practice regularly.

    I still have a small scar from being bitten, went to the Grand Jury on that one. She got 2 felony count convictions for battery on a health care worker.
  4. by   FolksBtrippin
    If a patient threatens violence when you are giving care, you need to stop what you are doing and assess.

    Consider whether the patient is refusing care, which is their right. "I'll punch you in the face" is an extreme way of saying "No." Is this happening because of pain? Anxiety? Assess for other causes or contributing factors like confusion, dementia, lack of sleep, privacy, cultural barriers, need for education.

    Some interventions would be letting patents take off their own tape, administering prns, etc.
  5. by   GaryRay
    The ANA has an Advacacy Panal specifically adressing the issue of violence towards nurses in the workplace. They also have been doing research on unit bullying prevention, and changing the acceptance culture.

    They have an E-book on the website that is really good called Not Part of the Job: How to Take a Stand Against Violence in the Work Setting its $28 for ANA members and $33 for non-members. eBook - Not Part of the Job: How to Take a Stand Against Violence in the Work Setting

    They also have a lot of good resources and articles. It's really important that we stop accepting abuse as a byproduct of working in healthcare, and we take a unified stance against it. The ANA is also lobbying to make assault against a healthcare worker a felony offence (just like a police officer or first responder). It doesn't cost that much to join if you aren't a member and your membership dues are applied toward countless causes like this.
  6. by   NurseVal93
    Quote from LonghornChic
    If de-escalation doesn't work then I assess their mental status. If they are pretty oriented and know what they are doing then I say "since you know what you are doing then I should inform you that hitting a nurse is considered a felony". I ususally get an apology afterwards and make sure to document that interaction. We let ourselves get abused too much.
    Wait, how am I a nurse and did not know that hitting a nurse is considered a felony?
    Is that in all 50 states?.. I am in CA.
  7. by   ~♪♫ in my ♥~
    Quote from OrganizedChaos
    So far in my short few months on the floor I've already had a bunch of patients threaten to hit me. Every time I get threatened or yelled at by the public all I can think of is that I'm not getting paid enough to put up with this ****.

    What do you do when someone just threatens violence? If I just called security on my ascom who knows when they would show up. But I don't feel the need to call a code since nothing is actually happening & I don't want to make the patient more irate.

    Yesterday I was trying to remove a patient's IV (she was being D/C'd). She had paper thin skin & lots of tape. I was trying to go as slow as possible & use ETOH pads & then hand sanitizer. She wasn't good with pain & at one point she said she was going to punch me in the face. What do you do in a situation like that? I just quickly changed the conversation & de-escalated her, then she was fine.
    I've been threatened a number of times, up to and including a threat by a patient to get a gun and hunt me down, as well as my family.

    In the moment of being threatened, I immediately and forcefully reply that I will not tolerate such threats while immediately backing away and taking steps toward my personal defense. I then chart what happened and notify my supervisor. I then refuse to provide care for the patient without sufficient resources present to ensure my safety. If appropriate, I then contact law enforcement to report the threat.

    The specifics of my response are completely dependent on the nature and credibility of the threat as well as my assessment of my personal risk.
  8. by   Ambersmom
    I take it in the context of how they said it, their age, and ability to carry through on the threat. I am thankful to have had CPI training, and I firmly believe EVERY healthcare worker shoukd have CPI (crisis prevention intervention) training. It has definitely saved my butt on many occasions.
  9. by   Have Nurse
    If you have patients that are prone to violence, have someone in the room with you when you are needed.

    If the patient is not confused, and just being a bully, you can threaten to call law enforcement. I had to do that when a young man (very big and strong) literally tossed me against the wall in his bathroom after I answered his call light. He had been smoking and we spoke a few times about it because he had been caught smoking in his bathroom. I told him I would have no problem alerting the Fire Marshall as it is prohibited here in MN.

    He got angry and called me names, taunting me and then assaulted me. When I tried to hit the Emergency Light, he kept resetting it. It was late at night and I didn't want to alarm others, so I managed to get out of his room by his shoving me out the door. I called the Police in addition to the House Supervisor and my Charge.

    He left AMA down the back stairs but the Police picked him up. I had to give a statement to them the next day at Police HQ. I did not lose my job, although the House Super was a bit annoyed that she wasn't notified first. I didn't care. Time was of the essence and he was dangerous. I did not lose my job. Your safety comes first in a situation like that. Document it, report it and follow up.

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